Septic complications owing to infection of necrotic areas are the main cause of mortality during severe acute pancreatitis. The necrotic tissue, originally sterile, constitutes an ideal pabulum for several bacterial species, translocated from the colon or originating from distant septic foci. The most important predisposing factor to infection is the extent of pancreatic necrosis, which correlates significantly with the risk of sepsis. The treatment of necrotizing pancreatitis should include measures that may prevent infection of the necrosis, such as reduction of bacterial translocation, treatment of septic systemic foci and stimulation of the immune system. The role of antibiotics in prevention is still debated; according to recent studies, imipenem and quinolones are the only antibiotic with a wide spectrum of action and the ability to penetrate the pancreas at therapeutic concentrations in the course of the disease. They are, therefore, the antibiotics of choice in the prevention of infected necrosis.

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